[Superficial gastric cancer. Results of surgery in 30 cases (author's transl)]

Gastrectomy was performed in 30 patients with superficial gastric cancer, equivalent to 12 p. cent of cases operated upon for gastric neoplasms since 1970. Presenting signs were epigastralgia in 19 cases (in 12 cases of the ulcer type), external bleeding from the digestive tract in 4 cases, dyspeptic disorders in 2 cases, and anaemia in one patient. The lesion was asymptomatic in 4 cases, while in 3 patients it was detected by endoscopy after polypectomy or for achlorhydria. In one case the lesion was discovered completely fortuitously. Cancer was suspected by the endoscopist from gross pathological findings in 7 of the 30 cases. An adenocarcinoma was diagnosed after biopsy in 26 cases, and suspected in the remaining 4 patients. Sub-total gastrectomy was employed in 27 cases, total gastrectomy in 2 cases, and extension to a total gastrectomy in one patient. Gross pathology showed cancer of type I : 8 cases, type II (IIa : 1, IIb : 0, IIc : 10) : 11 cases, type III : 6 cases, and mixed types IIc + III : 5 cases. The submucosa was invaded 17 times, the other 13 lesions involving the mucosa only. There were no immediate postoperative deaths. Three patients were not seen again, while 7 died from secondary causes : 5 for reasons unrelated to their cancer and 2 from unknown causes. By applying strict attention to surgical procedures and precise examination of histological data it should be possible to obtain postoperative survivals comparable to those of Japanese series (80 to 90 p. cent at 5 years, 70 p. cent at 10 years).

[Cytodiagnosis by needle aspiration-biopsy in pancreatic diseases : a preliminary study (author's transl)]

In this preliminary work, the first results concerning the cytodiagnostic of pancreatic diseases by needle aspiration are reported. 37 aspirations were carried out on 30 patients. 16 during the operation and 21 by transcutaneous way using arteriography in 16 cases, ultrasonic scanning in 3 cases, tomodensitometry in 2 cases, as a guide. In 7 patients, both way were used. Cancer of the pancreas was diagnosed by this technique in 10 cases out of 14, without accident. No results were falsely positive. Skill and good technique would seem to allow to decide between pancreatitis and cancer in doubtful cases and diagnose cancer of the pancreas sufficiently early.

[Verbal behavior and communication experience of psychosomatic patients in the first psychoanalytic interview in connection with the concept of "pensée opératoire']

This pilot-study was concerned with differences in speech behaviour and communication as experienced in psychoanalytically oriented initial interviews. In line with the ideas of Marty, Fain, de M'Uzan, David and Sami-Ali, 38 patients were divided into 3 diagnostic groups according to the extent of "pensée opératoire" and the level of functioning of the psychic sphere in each case. The communication experienced was recorded with the help of a communication questionnaire developed in Giessen. The speech behaviour for the interview as a whole and in its development over time was registered automatically and record in 29 categories by the Giessen Speech Analyzer. The following results are reported: --The two groups with more extensive "pensée opératoire" (A1, A2) differed from the character-neurotic patients in 13 of the 29 speech categories registered. The differences between groups A1 and A2 were not significant. --The communication as experienced by the patients did not differ between groups, but the therapist experienced the patients from the 3 diagnostic groups differently. The information gathered from the therapist in the communication questionnaire agreed by and large with the data collected automatically. --For the development of the interview over time, characteristic changes in the frequency of various speech categories were found but these were in the main unrelated to the diagnostic groupings.

[Benign tumours of the liver and oral contraceptives (author's transl)]

The pathologic features, the terminology, the etiolgoy, and the causal relations of benign tumours of the liver associated with the use of oral contraceptives were reviewed during a study on six new cases. According to the literature the following points are emphasized: these tumours can be divided into two distinctive conditions, they are commonly called focal nodular hyperplasia and liver cell adenoma, whereas the name hamartoma seems rarely appropriated, they occur without any use of oral contraceptive, but this practice is probably responsible for their increasing number.

[Psycho-somatic considerations in surgical contraception (author's transl)]

A group of 51 women who desired surgical sterilization were investigated by psychometry prior and after the operation. The results show that intra-psychic and inter-psychic factors need to be considered in the decision for surgical sterilization.

[Duodenal ulcer associated with a pyloric microgastrinoma and antropyloric focal gastrinosis (author's transl)]

In a patient with a duodenal ulcer, with acid hypersecretion and moderately disturbed gastrin secretion tests, immunocytochemical examination of the vagotomy-antrectomy specimen revealed a pyloric microgastrinoma (clinically silent and apparently benign) and focal antropyloric gastrinosis. These localised lesions represent a new variant of abnormalities affecting the gastrin cells in the context of hypersecretory duodenal ulcers.

Perhexiline maleate-induced hepatitis

5 patients treated with perhexiline maleate, 200-400 mg/day for at least 6 months, exhibited evidence of hepatitis. The picture was very similar to acute alcoholic hepatitis, clinically, biologically and histologically with presence of necrosis, Mallory's hyaline, polynuclear infiltration and to a lesser degree, steatosis. Association with peripheral neuropathy, hypoglycemia, and renal failure appears strikingly frequently. The evolution was severe since 3 patients died within 6 months, even after treatment withdrawal. Further studies are to be done to understand the mechanisms of hepatic and neurologic toxicity, and to measure the hazards of this drug. These studies could bring a new insight to alcohol toxicity.

[Generalized BCG infection in mixed and severe immunologic deficiency. Unfavorable outcome in spite of an attempted bone marrow transplant]

Generalized BCG infection can occur after vaccination in patients with a severe combined or T-cell immunodeficiency. In the reported case, generalized BCG infection developed in an infant with a severe combined immunodeficiency disease and presented mainly with hematological manifestations. This infection led to death of the patient in spite of an histocompatible bone marrow transplantation performed late in the course of the disease and followed by a minimal graft-versus-host reaction. Based on this case report and others from the literature, it is suggested that neonatal BCG vaccination should be performed after knowing at least the complete family history. Although the presented patient died, it should seem reasonable to treat such patients with an early immunological reconstitution and with anti-TB antibiotics.

Gestosis and the psychosomatic phenomenon--an empirical investigation

Patients suffering from psychosomatic diseases in the strict sense of the term (asthma, ulcers, colitis etc.) have characteristic object relations which we call the 'relation blanche'. The present investigation aims at finding out whether similar features can be observed in patients suffering from early and late gestosis. The results indicate that there is a definite connection between gestosis and the group of strictly psychosomatic diseases, thus confirming our hypothesis that gestosis does not primarily represent a neurotic conflict situation nor a psychotic breakdown.

A 4-year follow-up study of in-patient psychosomatic patients

The subjects of the inquiry were 13 psychosomatic patients who had all undergone psychotherapy in the special research unit of the University Clinic for Psychosomatics in Giessen (FRG) in 1971. Data collection took place at the beginning (time a) and end (time b) of in-patient treatment, and then again 4 years later (time c). The same test battery was administered each time. The results indicate that a significant change in the patients' self-image came about during in-patient treatment and the catamnesis carried out 4 years later attests to the stability of this development. The question of whether this change reflects the patient's adjustment to the ideals of his therapist--conformity with the 'norm'--or can be interpreted as a criterium for true ego development in the sense of an expansion of his psychic possibilities, is discussed.

[Encephalic pseudotumoral toxoplasmosis in the course of blood diseases]

The authors report two cases, the first pathological and the second clinical of pseudo-tumoural cerebral toxoplasmosis, occurring during the course of blood diseases. They refer to the conditions of appearance of this rare complication, with only twenty cases recorded in the literature, during malignant blood diseases. They stress the primordial role of immunological deficiency related either to the underlying disease (especially Hodgkin's disease) or to immuno-suppressive therapy. The clinical picture, with little in the way of typical features, is thus that of a diffuse méningo-encéphalitis. Pseudo-tumoural forms are rare. The authors also stress the minimum conditions required for the validity of the dye test and the value of the diagnosis of cerebral toxoplasmosis. An association of sulphadiazine-purimethamine, active and effective, cured the second patient.

Antigenic activity in monkey and human of purified low molecular weight fractions of Timothy pollen

Small molecular weight fractions obtained from dialysis of crude Timothy pollen extract were shown to carry immunogenic activity in monkeys. Three fractions were sequentially purified through gel filtration with Siphadex G-10 and C-M cellulose 52. Monkeys immunized with these fractions produced almost exclusively skin-sensitizing antibodies which were shown to be of the IgE class and differing in antigenic specificity. The analysis of sugars and amino acids contained in two of these fractions showed large qualitative and quantitative differences. It is assumed that these fractions might represent oligomeric subunits of larger antigenic molecules. Challenge of patients allergic to Timothy pollen by means of skin tests and nasal provocation tests further confirms the absence of cross-antigenicity among the 3 active fractions. These results seem to indicate heterogenicity of IgE antibodies as developed following sensitization with crude Timothy pollen antigen.